PICC or PORT Line for Chemo?

“To PICC or PORT, that is the question:” With apologies to the Bard of Avon, my topic today is to discuss some of the differences between a PICC line and a PORT for chemotherapy.

A PICC is a Peripherally Inserted Central Catheter. It is essentially an intravenous (IV) line that is inserted into a peripheral vein, typically in the upper arm, and advanced until the catheter tip terminates in a large vein in the chest near the heart to obtain intravenous access. It is similar to other central lines such as Central Lines or Ports as it terminates into a large vessel near the heart (the superior vena cava). However, unlike other central lines, its point of insertion is from the periphery of the body and usually a vein in the upper arm is the most common insertion point.

Unlike a standard IV line which is inserted in an arm or hand vein and terminates after only a few centimeters, A PICC line is usually inserted in the arm using ultrasound to guide the specially trained nurse or technician who is doing the insertion. PICC lines differ from peripheral IV access but are similar to central lines in that a PICCs termination point is centrally located in the body allowing for treatment that could not be obtained from standard periphery IV access, such as chemotherapy, prolonged antibiotic treatment or TPN nutrition. PICCs can also be used to draw blood samples. PICC insertions are less invasive, have decreased complication risk associated with them, and can remain in place for chemotherapy use for up to 6 months, perhaps longer if properly cared for. After the nurse or technician inserts the PICC, they may order a chest x-ray to confirm ideal placement. The entire procedure can be done in a patient’s room or a clinic exam room.

The PICC may have single or multiple lumens. A lumen is simply an access port with its own line that terminates in a junction prior to the point of insertion in the arm – think of a straw that has more than one mouth end prior to forming into a single tube before entering a milkshake! Whether a patient has one or more lumens depends on how many intravenous therapies are needed. The other feature of a PICC is that it needs to be flushed constantly with small amounts of heparin in order to keep the line from clotting. The disadvantage here is that because of its placement on the arm, someone else has to be taught how to do this for the patient (unless you’ve got three functioning arms) as it is impossible to do oneself. PICC Lines must be covered when showering and you really can’t go swimming with one in place. I used Saran Wrap and cloth first aid tape to keep mine covered when showering. I have heard others used Press N’ Seal or some variation of plastic wrap to keep theirs dry.

A Port (or Portacath®) is a type of central line that, like a PICC, has an intravenous line that terminates into a major vessel near the heart. Unlike a PICC line though a PORT has a small reservoir which is under the skin and which is accessed by a special needle when a patient has to receive chemotherapy, TPN, blood products or have frequent blood tests. The PORT reservoir is completely contained under the skin once implanted and therefore does not require flushing with heparin as often as a PICC line does. A PORT has to be implanted by a physician under local anesthesia. Also, one of the big advantages of a PORT is that once the incision heals, the patient can shower or swim without having to cover the PORT like they would with a PICC; nothing remains visible on the outside of the body. Another advantage is that a PORT can stay in place for several years, whereas the realistic lifespan of a PICC line is usually 4-6 months.

An alternative to a PORT is a Central line that is inserted in the chest and extends into a major vessel. In this respect it is very similar to a PICC, except that the end of the line and lumen are on the outside of the chest, instead of on the outside of the arm.

I personally had a PICC line inserted first as it was the fastest way for my team to get me lined up for chemo late on a Friday afternoon; The PICC, as you recall, can be inserted by a trained nurse. I had my PICC for 4+ months and was having chemotherapy every 2 weeks. I opted to have the port put in last December as it really offers much more freedom; for example, with the PICC I had to have a family member flush it with heparin solution every night and change the dressing at least once a week, more if I undertook heavy exercise. I would also have to cover my arm in Saran Wrap as you cannot get a PICC insertion wet when showering. PICCs limit your independence somewhat but if therapy is planned for a short time they will work well.

When I had my PORT inserted, once the incision site healed after a few days I was able to shower and swim and the chemo nurse flushes it once every two weeks when I was in for chemotherapy. Pain after incision was minimal and anesthesia was an outpatient twilight sleep – Propofol (e.g., Diprivan®)or Midazolam (e.g., Versed®). The chemo infusion insertion is with a special needle and I hardly feel anything, although if the thought of a needle piercing the skin makes you squirm the nurse can numb the area with a topical anesthetic first. Every patient that I have talked to has commented they were so happy to get a port as it offered up much more flexibility and freedom than a PICC line.

The following web site has some excellent illustrations of the different types of central lines and PORTs described above:

Well done Mark !! Just as Joanne stated, it was technical yet easy to understand. You have a wonderful way of explaining all the details as if you were talking face-to-face with a person. Keep up the good work, little cousin.
Love,
Laura

I had 3rd stage colorectal cancer and had surgery May 4th 2010
I had a picc line the 12 days I was in the hospital, I love the chest port idea.
I see a video on tv of a little girl getting stuck with a needle in her chest and it broke my heart when she smiled at the nurse right after, Now I realize it was a port and that she felt no pain, Knowledge is power, I will be getting my port soon. God and my surgeon william Danael, made an awsome team, Hope to return and give an update soon, please make my email available to all so I may talk to others with cancer or a port, or just anyone going through radiation and or chemo, Thanks…Donnie

Donnie – Hope all is well and your recovering from your surgery without any complications. I had a PICC Line and the Port is a HUGE improvement, allows you to swim, shower and not have to flush nightly.

Thanks for offering to talk to anyone re cancer, port, radiation and or chemo – that is not only very generous but very very kind of you as well. I will be more than happy to connect anyone with you who has questions, but feel kind of uneasy putting your email out there for all to see. Would rather introduce anyone on a one on one basis. Hope you understand. Thanks again and hang tough!!!
– Mark

I have a ? about the length of time one can keep a port. I have had mine 5yrs in Sept and have had no problems. My Doc wants me to have it removed. It was placed originally for Cytoxan infsion for my Multiple Sclerosis, not cancer tx. I am not getting the Cytoxan each month ( the new Dr discontinued the Cytoxan, my other Dr passed on) but still getting IV Solu-medrol(steroid). My peripheral veins are poor and I hate to go thru all that again. Anyone have any hard data on lifespan of a port?

Yay! I’m getting a port next week because I’m a hard stick. My veins are tiny and they roll. I hate needles but I’m use to them by now but a port will make getting my meds for MS SOOO much easier for my nurses and myself. I’ll also use soon of this information for when I go to speak and teach about living with this illness! After all, I have MS; it doesn’t have me!!! :)

Thank you for the in-depth descriptions! My friends and I had relatives going through treatments similar to what you’ve described and we decided to create a specialty line of clothing for them. Our clothing has zippers in the arms and chest for PICCs and Ports. The main goal was to help them stay warm and comfortable during treatment without having to worry too much about what to wear. If you would like more information, you can visit our site http://www.LibreClothing.com or give me an email Eckman@LibreClothing.com.

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This Blog is generated by a current cholangiocarcinoma patient and is intended as a resource for other cholangiocarcinoma patients, their families and caregivers.
Please note: I am not a healthcare provider. Nothing on this Blog qualifies as certified medical advice. Information on this Blog including links to other sites is provided free and is for informational purposes only. Any opinion stated on this Blog is solely that of the author and does not represent the opinion of WorldPress.com or any other institution referred to in the Blog.